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A year into COVID-19, medical oxygen scarcity still costing lives

March 19, 2021 by Nikolaj Gilbert

Oxygen access is a matter of life or death. The world can and must do better to increase equitable access to medical oxygen.

About 15 percent of all people with COVID-19 require oxygen support, but countries around the world are struggling to meet this demand.  Photo: Pixabay/Michael Schwarzenberger.

About 15 percent of all people with COVID-19 require oxygen support, but countries around the world are struggling to meet this demand. Photo: Pixabay/Michael Schwarzenberger.

The World Health Organization declared COVID-19 a pandemic one year ago. Thanks to unprecedented collaboration, the public health community has made significant progress since then.

The rapid development of tests, treatments, and vaccines against COVID-19 is a collective achievement that should be celebrated. And thanks to COVAX, more than 50 low- and middle-income countries (LMICs) and territories have received COVID-19 vaccine doses thus far, with plans for broader rollout in progress.

Despite these achievements, too many communities are still lacking in one key area: reliable oxygen access.

The deciding factor

Access to medical oxygen can be the deciding factor for who lives and dies during this pandemic. Approximately 15 percent of all people with COVID-19 require oxygen support. In LMICs, an estimated half a million people require 1 million cylinders of oxygen every day. But health systems are unable to meet the demand.

Countries around the world—such as Brazil, India, Jordan, Nigeria, Pakistan, South Africa, Zimbabwe, and more—are reporting oxygen shortages on a daily basis. Media reports also suggest black markets are emerging, and prices for medical oxygen have increased several fold in Brazil, Mexico, Pakistan, and Peru.

Now is the time to prioritize medical oxygen. Oxygen should be treated as an essential utility, as vital as electricity or water.

The global community has an opportunity to implement systemic solutions that save lives now and increase oxygen access in the long-term, but it won’t be easy. It will require an integrated set of solutions—from addressing market inefficiencies that cause supply shortages to building supportive policy environments and providing specialized training for health workers.

Ending oxygen scarcity

We’re starting to see some promising changes. In recognition of oxygen’s central importance as a treatment for COVID-19, the World Health Organization announced last month that oxygen therapy would move into the therapeutics pillar of its Access to COVID-19 Tools (ACT) Accelerator.

Alongside this shift, Unitaid and Wellcome—co-leaders of the ACT Accelerator’s therapeutics pillar—launched the COVID-19 Oxygen Emergency Taskforce, which brings together key players, including PATH, to measure need, increase financing, support increased supply, and elevate advocacy.

I applaud these critical steps in the right direction, but as a global community we must do more.

Oxygen should be treated as an essential utility, as vital as electricity or water.

First, we must be able to understand and quantify oxygen needs. During the first six months of the pandemic, PATH and a consortium of partners collected baseline information on oxygen access in 14 countries. It was a necessary starting point for responding to the anticipated and growing need. This data is invaluable today, but we need much more of this work going forward.

We must provide a suite of tools, paired with funding for technical assistance, to enable more national governments to better assess their oxygen needs, usage, and supply. Policymakers and facility managers need timely, accurate data to make informed decisions and begin proactively planning medical oxygen access.

Second, we need funding for both short- and long-term supply needs. At the start of the pandemic, international organizations began distributing oxygen concentrators—self-contained electrical devices that concentrate oxygen from the surrounding air—in LMICs. While concentrators can be a great solution in some settings, in many contexts, they’re not sustainable or adequate for meeting long-term needs.

We should identify and invest in appropriate long-term solutions, whether it is liquid oxygen, oxygen generation plants, or cylinder distribution networks (needs will differ for each country and context). Funding must cover not only initial procurement, but also operating costs for maintaining systems over time.

Third, we must leverage innovative public-private partnerships. The global financing community and oxygen suppliers must work together to guarantee stable, long-term supply to countries with high oxygen needs. Innovative partnerships can help change the way medical oxygen is procured and financed, creating a robust oxygen delivery infrastructure while mitigating risk between suppliers and buyers.

This can include negotiating long-term service agreements with bulk oxygen suppliers (and their local subsidiaries) and subsidizing costs during this critical time. Ideally, these service agreements would include terms that apply well beyond the pandemic.

And finally, domestic financing must be built into long-term policy. Including oxygen investment in national policies, programs, and budgets can save money in the long run and improve health outcomes across all populations. In Ethiopia, for example, early investment paid off. In 2015, the government, in partnership with the Clinton Health Access Initiative, conducted an oxygen assessment. Based on this assessment, it adopted a road map for scaling up medical oxygen. From there, Ethiopia procured more than 3,000 oxygen concentrators and established five new oxygen generation plants. When the COVID-19 began, demand skyrocketed higher than initial projections, but with policies and plans already in motion, the country had a substantial head start.

Lack of medical oxygen is one of the defining health inequities of our age. Oxygen therapy can save millions of lives—from treating heart failure and pneumonia to asthma and COVID-19. Global donors, multilateral organizations, and national governments must act together now to invest in oxygen and close wide gaps in access in LMICs. We must continue addressing immediate needs associated with COVID-19, but we must do so while building strong systems to ensure sustainable oxygen access for the future.

Nikolaj Gilbert is president and chief executive officer of PATH and managing director of PATH's Swiss subsidiary, Foundation for Appropriate Technology in Health. He has more than 20 years of international experience as a leader, strategist, and director of complex partnerships. Before joining PATH in 2020, Mr. Gilbert served as director of the United Nations Office for Project Services.

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